I think the very first step is helping them get through denial; helping them to see that they really are in a psychiatric syndrome that takes more lives of females every year than anything else. Over 500,000 deaths occur yearly as a consequence of eating disorders. So part of the treatment process is for them to do what we call "separate," differentiate from their eating disorder to get through the denial. Then we begin to understand what may have contributed and then to re-establish a balanced relationship with food. I don't mean they develop an ideal balance relationship with food but a nutritionally more stable relationship with food, because most of the people whether they are underweight or not are nutritionally deprived. They are just not equipped to cognitively process. They think in a distorted fashion and their distortion is their reality so if they are feeling so intense, that it is difficult. I don't expect it would be extremely unrealistic if they are going to sit down and have a balanced meal. They have intense fears and just cannot do that, so we gradually help them move and challenge and know that they will survive their feelings associated with food to become more nutritionally stable. As we are doing that, most people who have eating disorders also are neurochemically imbalanced and you can't really check that because you would have to extract cerebrospinal fluid and so symptomatically. Historically, we have known through the years that anti-depressants help to reestablish a serotonin balance and other neurotransmitter balances so that people can begin to think more rationally. As their body is nutritionally stabilized and chemically stabilized, they can embrace reality as opposed to being caught in the extreme fears they have been experiencing in that imbalanced state.
